ID

10106

Beschrijving

RTOG-0421 I6: Radiation Therapy Oncology Group Phase III Recurrent Head and Neck Study Staging Diagrams / Oral Cavity Combination Chemotherapy With or Without Radiation Therapy in Treating Patients With Recurrent Head and Neck Cancer That Cannot Be Removed By Surgery NCT00113399 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=EB499DEC-47D0-3F31-E034-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=EB499DEC-47D0-3F31-E034-0003BA3F9857

Trefwoorden

Versies (3)
  1. 19-09-12 19-09-12 -
  2. 09-01-15 09-01-15 - Martin Dugas
  3. 30-03-15 30-03-15 - Martin Dugas
Geüploaded op

30 maart 2015

DOI

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Licentie

Creative Commons BY-NC 3.0 Legacy
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Head and Neck Cancer Staging Diagrams Oral Cavity NCT00113399 RTOG-0421 I6

Engels

No Instruction available.

1 Formulieren  
  1. StudyEvent: RTOG-0421 I6: Radiation Therapy Oncology Group Phase III Recurrent Head and Neck Study Staging Diagrams / Oral Cavity
    1. No Instruction available.
Header
Beschrijving

Header

Alias
UMLS CUI-1
C1320722
RTOG Study
Beschrijving

Protocol ID RTOG

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C1514695
NCI Thesaurus Property
C19778
NCI Thesaurus Property-2
C25364
Case #
Beschrijving

RadiationTherapyOncologyGroupPatientCaseIdentifierNumber

Datatype

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus ObjectClass-2
C19778
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C49152
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C0868928
Institution Name
Beschrijving

Institution Name

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass
C21541
NCI Thesaurus ValueDomain-2
C21541
NCI Thesaurus Property
C25364
Institution No.
Beschrijving

Institution Number

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass
C21541
UMLS CUI-2
C0805701
NCI Thesaurus Property
C25364
Patient Initials
Beschrijving

Patient Initials

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Patient Study No.
Beschrijving

Trial subject ID RTOG

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C1514695
NCI Thesaurus Property
C19778
NCI Thesaurus Property-2
C25364
If this is a revised or corrected form, indicate by checking box.
Beschrijving

CaseReportFormModifiedInd-2

Datatype

text

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C40988
UMLS 2011AA ObjectClass
C1516308
NCI Thesaurus Property
C25573
Signature
Beschrijving

Signature

Datatype

text

Date
Beschrijving

ResponsiblePersonSignatureDate

Datatype

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass-2
C25657
UMLS 2011AA ObjectClass-2
C1273518
NCI Thesaurus Property
C25678
UMLS 2011AA Property
C1519316
Head and Neck cancer characteristics
Beschrijving

Head and Neck cancer characteristics

Indicate side of lesion (R or L)
Beschrijving

HeadandNeckTumorSideType

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25284
NCI Thesaurus ObjectClass
C3262
NCI Thesaurus ObjectClass-2
C12418
NCI Thesaurus Property
C25306
UMLS CUI-1
C0441987
CHARACTERISTICS OF TUMOR
Beschrijving

HeadandNeckTumorCharacteristicsType

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25284
NCI Thesaurus ObjectClass
C3262
NCI Thesaurus ObjectClass-2
C12418
NCI Thesaurus Property
C25447
UMLS CUI-1
C0027651
UMLS CUI-2
C1521970
LOCATION OF TUMOR ( all that apply)
Beschrijving

HeadandNeckTumorSite

Datatype

text

Alias
NCI Thesaurus ValueDomain
C13717
NCI Thesaurus ObjectClass
C3262
NCI Thesaurus Property
C25341
NCI Thesaurus ObjectClass-2
C12418
UMLS CUI-1
C0872338
SITE OF ORIGIN
Beschrijving

HeadandNeckTumorOriginLocationStatus

Datatype

text

Alias
NCI Thesaurus ObjectClass
C12418
NCI Thesaurus ObjectClass-2
C3077
NCI Thesaurus Property
C13717
NCI Thesaurus Property-2
C42703
NCI Metathesaurus ValueDomain
CL052713
UMLS CUI-1
C0449689
SITE(S) ALSO INVOLVED
Beschrijving

HeadandNeckTumorInvolvedLocationStatus

Datatype

text

Alias
NCI Thesaurus ObjectClass
C3262
NCI Thesaurus ObjectClass-2
C12418
NCI Thesaurus Property
C25341
NCI Thesaurus Property-2
C25547
NCI Metathesaurus ValueDomain
CL052713
UMLS CUI-1
C2732472
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No Instruction available.

1 Formulieren
  1. StudyEvent: RTOG-0421 I6: Radiation Therapy Oncology Group Phase III Recurrent Head and Neck Study Staging Diagrams / Oral Cavity
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Header
C1320722 (UMLS CUI-1)
Protocol ID RTOG
Item
RTOG Study
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1514695 (UMLS CUI-2)
C19778 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Case ID
Item
Case #
text
C16960 (NCI Thesaurus ObjectClass)
C19778 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C49152 (NCI Thesaurus Property-2)
C25337 (NCI Thesaurus ValueDomain)
C0868928 (UMLS CUI-1)
Institution Name
Item
Institution Name
text
C25191 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C21541 (NCI Thesaurus ValueDomain-2)
C25364 (NCI Thesaurus Property)
Institution Number
Item
Institution No.
text
C25337 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C0805701 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
Patient Initials
Item
Patient Initials
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Trial subject ID RTOG
Item
Patient Study No.
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1514695 (UMLS CUI-2)
C19778 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
CaseReportFormModifiedInd-2
Item
If this is a revised or corrected form, indicate by checking box.
text
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C40988 (NCI Thesaurus ObjectClass)
C1516308 (UMLS 2011AA ObjectClass)
C25573 (NCI Thesaurus Property)
Signature
Item
Signature
text
ResponsiblePersonSignatureDate
Item
Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25657 (NCI Thesaurus ObjectClass-2)
C1273518 (UMLS 2011AA ObjectClass-2)
C25678 (NCI Thesaurus Property)
C1519316 (UMLS 2011AA Property)
Item Group
Head and Neck cancer characteristics
Item
Indicate side of lesion (R or L)
text
C25284 (NCI Thesaurus ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C12418 (NCI Thesaurus ObjectClass-2)
C25306 (NCI Thesaurus Property)
C0441987 (UMLS CUI-1)
Side
Code List
Indicate side of lesion (R or L)
CL Item
right (R)
C0205090 (UMLS CUI-1)
CL Item
left (L)
C0205091 (UMLS CUI-1)
Item
CHARACTERISTICS OF TUMOR
text
C25284 (NCI Thesaurus ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C12418 (NCI Thesaurus ObjectClass-2)
C25447 (NCI Thesaurus Property)
C0027651 (UMLS CUI-1)
C1521970 (UMLS CUI-2)
CL.1
Code List
CHARACTERISTICS OF TUMOR
CL Item
Deeply Infiltrating (Deeply infiltrating)
CL Item
Normal Mobility Of Tongue (Normal mobility of tongue)
CL Item
Impaired Mobility Of Tongue (Impaired mobility of tongue)
CL Item
Fixed Tongue (Fixed tongue)
CL Item
Gross Erosion Of Bone (Gross erosion of bone)
CL Item
Radiographic Bone Destruction (Radiographic bone destruction)
Item
LOCATION OF TUMOR ( all that apply)
text
C13717 (NCI Thesaurus ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C25341 (NCI Thesaurus Property)
C12418 (NCI Thesaurus ObjectClass-2)
C0872338 (UMLS CUI-1)
CL.2
Code List
LOCATION OF TUMOR ( all that apply)
CL Item
Oral Tongue (Oral tongue)
CL Item
Floor Of Mouth (Floor of mouth)
C0026638 (NCI Metathesaurus)
CL Item
Retromolar Trigone (Retromolar Trigone)
CL Item
Upper gingiva (Upper gingiva)
CL Item
Lower Gingiva (Lower gingiva)
CL Item
Buccal Mucosa (Buccal mucosa)
C12505 (NCI Thesaurus)
C1578559 (UMLS 2011AA)
CL Item
Hard Palate (Hard palate)
C12230 (NCI Thesaurus)
C0226901 (UMLS 2011AA)
CL Item
Upper gingiva (Upper gingiva)
CL Item
Upper Lip (Upper lip)
CL Item
Lower Lip (Lower lip)
CL Item
Commissure (Commissure)
Item
SITE OF ORIGIN
text
C12418 (NCI Thesaurus ObjectClass)
C3077 (NCI Thesaurus ObjectClass-2)
C13717 (NCI Thesaurus Property)
C42703 (NCI Thesaurus Property-2)
CL052713 (NCI Metathesaurus ValueDomain)
C0449689 (UMLS CUI-1)
CL.3
Code List
SITE OF ORIGIN
CL Item
Right (RT)
C25228 (NCI Thesaurus)
C0205090 (UMLS 2011AA)
CL Item
Left (LT)
C25229 (NCI Thesaurus)
C0205091 (UMLS 2011AA)
Item
SITE(S) ALSO INVOLVED
text
C3262 (NCI Thesaurus ObjectClass)
C12418 (NCI Thesaurus ObjectClass-2)
C25341 (NCI Thesaurus Property)
C25547 (NCI Thesaurus Property-2)
CL052713 (NCI Metathesaurus ValueDomain)
C2732472 (UMLS CUI-1)
CL.4
Code List
SITE(S) ALSO INVOLVED
CL Item
Right (RT)
C25228 (NCI Thesaurus)
C0205090 (UMLS 2011AA)
CL Item
Left (LT)
C25229 (NCI Thesaurus)
C0205091 (UMLS 2011AA)
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